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Memoirs of the Addams Administration 8.

From the New Deal through the Seventies, the “closed shop” provided a major source of union membership.[1] Union membership has declined from 20.1 percent of workers in 1983 to 10.7 percent in 2016. Now, a majority (28/50) of states are “right to work” states where compulsory membership in unions is outlawed.[2] President Trump has further undermined union sympathy by calling for heavy spending on long-overdue infrastructure projects, by promising to revise trade agreements, and by adopting a stance of “America First.” All these are things that Democrats or Republicans might have done, but did not do, in years gone by.

There are an estimated 11 million illegal immigrants in the United States.[3] The vast majority are Mexicans who fled their failing-state homeland for the opportunity to work in the United States. They perform many tasks—and perform them well–that other Americans do not desire to perform. To put it mildly. That reality argues for allowing the illegals to remain as legal workers, if not as candidates for citizenship. On the other hand, the obvious presence of the illegals drives a lot of Americans wild. OK, the illegals cluster in the places—farm fields in Georgia or Arizona, hardware store parking lots, landscaping businesses, the kitchens of restaurants, faculty office buildings—or at the times—early in the morning or late at night–where high-income, highly educated people would not notice them. Some native-born Americans feel that their culture is being swamped by a foreign culture. Some of them think that the laws are being flouted by Republican businessmen avid for cheap labor and by Democratic politicians—who insist upon a “path to citizenship” for the “undocumented”–avid for potential voters. Both of the latter headings play into a feeling that the system is rigged by the “elites” for their own benefit. Senator Bernie Sanders caught part of that feeling. That feeling is part of what brought Donald Trump to the White House.

The Republicans have embraced “repeal and replace” for the Affordable Care Act. Replace with what? That’s where things are getting tricky. Republicans who dare to think about the nuts and bolts favor market-based solutions. They believe that “consumers” who approach medical care as a “commodity” will be bargain-hunters.[4] That, in turn, will hold health care costs in check. How to make people into cost-conscious consumers? At the moment, an expanded system of Health Savings Accounts (HSAs) is being much caressed. The HSAs allow people to divert pre-tax income to an individual fund that can be used to pay for things like deductibles and co-pays. Usually, such HSAs run with a high-deductible health insurance policy. About 30 percent of employers now offer high deductible + HSA insurance to their workers. Republicans propose to raise the current caps on annual contributions ($3,400 individual/$6,750 family) to at least the maximums set by the insurance policy for out-of-pocket and deductible costs.

Given Americans’ reluctance to save for predictable calamities like old age, it’s a little much to expect them to save for unpredictable calamities like medical problems.[5] One solution might be to make such contributions mandatory, or at least require an Opt-Out decision. Thus, even Republicans are being driven by realities toward a form of the nanny-state.